Durability, Negative Impact, and Neuropsychological Predictors of Tic Suppression in Children with Chronic Tic Disorder

Abstract

Chronic tic disorders are characterized by involuntary motor and vocal tics, which are influenced by contextual factors. Recent research has shown that (a) children can suppress tics for brief periods of time, (b) suppression is enhanced when programmed reinforcement is provided for tic-free intervals, and (c) short periods of suppression do not result in a paradoxical "rebound" in tic frequency when active suppression has ceased. The current study extended existing research in three important ways. First, we examined whether tic suppression ability decreased as suppression duration increased from 5 to 25 to 40 min. Second, we examined post-suppression tic frequency to test whether longer periods of suppression were more likely to be associated with a rebound effect. Finally, we explored neuropsychological predictors of tic suppression. Thirteen children with Tourette syndrome or a chronic tic disorder completed the study. Results showed that (a) tic suppression was sustained for all of the suppression durations, (b) rebound effects were not observed following any of the suppression durations, and (c) ability to suppress was correlated with omission, but not commission errors on a continuous performance task. Implications of these findings are discussed.

The influence of contextual factors on tic expression in Tourette's syndrome: A review

“…Across participants, there was no evidence of a rebound effect. These results have been replicated using larger sample sizes and longer durations of suppression [51]. Combined, these findings demonstrate that reinforcing tic suppression for up to 40 consecutive minutes reduces tics and does not lead to later exacerbation.…”

“…Although this study provides preliminary insight into the relationship between contextual factors, tics, and the premonitory urge, further research should be conducted to better understand how age, tic location, and particular urge experience impact this relationship. Combined, these studies [19,[47][48][49][50][51] provide experimental evidence that tic frequencies can be impacted by consequent stimuli. However, it is unclear if the tics themselves were modified.…”

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation

“…It should be noted that past concerns of tic suppression resulting in a so-called rebound effect have been more recently debunked. 8,9 Other behavioural treatments identified in the literature have insufficient evidence to recommend their use. Relaxation training in isolation lacks a sufficient evidence base to be considered a stand-alone efficacious treatment 10,11 but is often incorporated into HRT protocols.…”

Examining cortisol rhythmicity and responsivity to stress in children with Tourette syndrome

“…Voluntary tic suppression can result in a buildup of tension that some claim leads to a paradoxical rebound or outburst of tics (Bliss, 1980;Jankovic, 1997). However, some studies involving behavioral observation methods Meidinger et al, 2005;Woods et al, 2007) and intervention techniques (Verdellen et al, 2004) do not support the presence of a rebound effect.…”